RESUMO
Multiple myeloma is a malignant proliferation of plasma cells that affects mainly bone marrow but may also involve other organs as well. We report thoracic involvement in the form of left-sided pleural effusion, osseous lesions, bronchial infiltration, and mediastinal lymphadenopathy in a 61-year-old woman, non-smoker presented with chest pain, dyspnoea, cough and deterioration in general health over the preceding seven months. Immunoelectrophoresis and immunofixation showed raised kappa-light chain immunoglobulin G (IgG) in serum and pleural fluid. Bronchial and pleural biopsies documented myelomatous infiltration and bone marrow aspirate revealed extensive plasma cell infiltration. At eight months, following the fourth cycle of melphalan, endoxan and prednisone based chemotherapy, the patient died.
Assuntos
Mieloma Múltiplo/patologia , Neoplasias Torácicas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Neoplasias Torácicas/diagnósticoRESUMO
Tobacco increases the risk of pulmonary infection, especially tuberculosis. We try by this study to analyse this action. It's a comparative study between two groups of patients hospitalized in our department between January 2006 and June 2008. The first group was made of 30 smokers patients hospitalized because of confirmed pulmonary tuberculosis. The second group consists of 30 non smokers patients and also hospitalized because of confirmed pulmonary tuberculosis. Delay of diagnosis was longer in the group of smokers (3, 1 +/- 3 months versus 2 +/- 1 month with p = 0.039). The most frequent symptoms in both groups were cough and loss of weight. The biological investigations showed a high level of white blood cells with predominance of neutrophil cells especially in smokers (p = 0.024). Chest X ray showed essentially nodules in both groups. These nodules were bilateral in smokers (P = 0.045). Evolution after antituberculosis treatment was favourable for all patients. A delay of recovery (time between symptoms and recovery) was longer in smokers than in non smoker patients (p = 0.043). Pulmonary Sequels such as dyspnoea (p = 0.016) and fibrosis (p = 0.041) were most frequent in smokers. No patients had tuberculosis relapse. Tobacco may delay the recovery of pulmonary tuberculosis and may induce pulmonary sequels in spite of correctly antituberculosis treatment.
Assuntos
Mycobacterium tuberculosis , Neutrófilos/patologia , Fumar/efeitos adversos , Escarro/microbiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Tosse/microbiologia , Dispneia/microbiologia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Neutrófilos/efeitos dos fármacos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Prevenção do Hábito de Fumar , Resultado do Tratamento , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/tratamento farmacológico , Redução de PesoRESUMO
Osseous hydatidosis, especially when located in the rib, is a very rare disease. Less than 50 cases of costal echinococcosis have been reported in the literature to date. The authors report a case of echinococcosis of the rib with epidural extension in a 76-year-old patient presenting paraparesis. In addition, the patient presented a large posterior and thoracic soft tissue mass measuring about 30 centimetres in diameter. A chest x-ray, a CT thoracic scan and an MRI of the dorsal spine were performed. The imaging suggested echinococcosis of the rib with epidural extension. The cyst was completely resected. Histopathology of the resected specimen confirmed the diagnosis of echinococcosis. The patient died due to postoperative complications. Accurate presurgical diagnosis allows for appropriate management and helps eradicate the disease. This also prevents the dissemination of parasites and further complications.
Assuntos
Doenças Ósseas/parasitologia , Equinococose/diagnóstico , Espaço Epidural/parasitologia , Costelas/parasitologia , Idoso , Doenças Ósseas/diagnóstico , Doenças Ósseas/cirurgia , Equinococose/cirurgia , Espaço Epidural/cirurgia , Evolução Fatal , Humanos , Laminectomia , Masculino , Costelas/cirurgia , Compressão da Medula Espinal/parasitologia , Compressão da Medula Espinal/cirurgiaRESUMO
Hemothorax is generally secondary to trauma, invasive thoracic surgery or specific lung of pleural disease. Hemothorax secondary to aortic dissection is rare. We report a case in a 69-year-old man with a history of smoking and hypertension. The patient was referred for exploration of a left pleural opacity with mediastinal widening. Pleural puncture produced a hemorrhagic fluid. The thoracic scan led to the diagnosis of Stanford type B aortic dissection. The patient was given antihypertensive treatment and now has a sixteen month follow-up. Aortic dissection can give rise to hemothorax, especially in a hypertensive subject with an anomalous aortic arch or mediastinal widening on the chest X-ray. Computed tomography generally gives the diagnosis. Treatment may be medical or surgical, depending on the site of the lesion and the severity of the clinical presentation. Aortic dissection is a cause of hemothorax, particularly in patients with favorable conditions or a suggestive radiological anomaly.
Assuntos
Aneurisma da Aorta Torácica/complicações , Dissecção Aórtica/complicações , Hemotórax/etiologia , Idoso , Humanos , MasculinoRESUMO
INTRODUCTION: Broncholithiasis is defined as the presence of calcified material in the bronchial lumen. The aim of our work was to study the clinical, radiological and therapeutic aspects of broncholithiasis. OBSERVATIONS: We report the histories of 6 patients identified over 14 years (1990-2004). They included 4 men and 2 women with an average age of 50 years. A past history of pulmonary tuberculosis was found in 2 cases. The presenting symptom was haemoptysis in 4 patients. Fibreoptic bronchoscopy was performed in all patients and broncholiths were found in two. Thoracic CT scan was performed in 5 patients and in 3 showed hilar and parenchymal calcification, suggesting the diagnosis of broncholithiasis. The diagnosis was confirmed in 2 patients by bronchoscopy, in 2 others by surgical biopsy and in the remaining 2 by the CT appearances. Three patients were operated on: 2 for diagnosis and the third for haemostasis. Pulmonary tuberculosis was discovered in 2 patients, one by culture and the other by surgical biopsy. The outcome was satisfactory in all cases. CONCLUSIONS: Broncholithiasis presents a problem of differential diagnosis from other pulmonary pathologies on account of misleading clinical, endoscopic and radiological features.
Assuntos
Broncopatias/diagnóstico , Litíase/diagnóstico , Adulto , Idoso , Biópsia , Broncopatias/complicações , Broncopatias/cirurgia , Broncoscopia , Diagnóstico Diferencial , Feminino , Hemoptise/etiologia , Humanos , Litíase/complicações , Litíase/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Pulmonar/complicaçõesRESUMO
Solitary plasmocytoma is a rare tumor accounting for 5% of all plasma cell neoplasias. The diagnosis is based on identification of the localized tumor composed of monoclonal plasma cells identical to those observed in multiple myeloma, and absence of the signs in favor of a disseminated form. We report the case of a52-year-old man who presented a growth of the chest wall in the left axillary region. Imaging disclosed a mass of tissue with a large zone of osteolysis of the 6th rib and infiltration of the chest wall. Surgical biopsy for pathology study and immunohistochemistry enabled the diagnosis of costal plasmocytoma. Blood protein immunoelectrophoresis revealed a monoclonal kappa type IgG. Bence-Jones proteinuria was positive. Search for other localizations was negative and the diagnosis of solitary plasmocytoma was retained. Radiotherapy was delivered and the patient has remained in remission at one year. Costal localization is rare for solitary plasmocytoma. The diagnosis is based on imaging findings and pathology. Radiotherapy is the treatment of choice but with the risk of progression with other bone lesions, the development of medullary plasmocytosis and multiple myeloma. Factors predictive of systemic recurrence have not been identified. Regular surveillance is required.
Assuntos
Neoplasias Ósseas/diagnóstico , Plasmocitoma/diagnóstico , Costelas , Neoplasias Ósseas/radioterapia , Humanos , Cadeias kappa de Imunoglobulina/sangue , Masculino , Pessoa de Meia-Idade , Plasmocitoma/radioterapia , Proteinúria/etiologiaRESUMO
INTRODUCTION: The features of paradoxical reactions (PR) that occurred in non-HIV infected patients are rare and not well known. CASE REPORT: The authors reported the case of a 21years old, non-immunocompromised, and HIV negative patient treated for disseminated tuberculosis. PR occurred after 8months after initiation of antituberculous treatment. PR presented as left cervical lymphadenopathy, pulmonary, pleural, costal and spinal location of the tuberculosis. The antituberculous drugs were prolonged. Patient's clinical symptoms improved initially. However, left inguinal lymphadenopathy appeared after 20months of antituberculous therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis. The patient has a good compliance to the treatment. The patient was continued on same antituberculous treatment for a total of 28months. The cervical and inguinal lymphadenopathy disappeared and CT scan showed regression of thoracic, abdominal, costal and spinal lesions. CONCLUSION: PR during antituberculous treatment must be considered after exclusion of other causes. No consensus on the therapeutic management of this entity has been developed to date.
Assuntos
Antituberculosos/uso terapêutico , Tuberculose dos Linfonodos/induzido quimicamente , Tuberculose Miliar/tratamento farmacológico , Humanos , Imunocompetência , Linfonodos/efeitos dos fármacos , Linfonodos/patologia , Masculino , Pescoço , Pelve , Adulto JovemRESUMO
Hydatid pulmonary embolism is a rare condition. Diagnosis is difficult and there is no consensus on treatment. Prognosis is generally poor. We conducted a retrospective analysis of patients hospitalized between 1994 and 2002 who had a diagnosis of hydatid pulmonary embolism. Seven cases were identified. All patients had a cyst which spontaneously ruptured into the bloodstream. All patients were symptomatic. Chest x-ray revealed images of metastatic pulmonary echinococciasis in all patients. Thoracic CT and/or angioscan provided the diagnosis in five patients. In one, the diagnosis was established with pulmonary angiography. For one other, the diagnosis was established at the pathology examination of the surgical specimen. Searching for the primary localization of the hydatid disease revealed hepatic cysts in all patients, associated in one with a cyst in the right atrium. The cardiac cyst was not operated and all hepatic cysts were removed. Embolectomy was performed in one patient. Medical treatment with albendazole was given in five patients. The clinical course was marked by death in two patients, due to abundant hemoptysia. The five other patients are followed regularly and were doing well at six months to five years. The diagnosis of hydatid pulmonary embolisms is basically obtained with imaging. Treatment is surgical resection of the embologenic focus then embolectomy. The role of medical treatment is not clearly defined. The short- and mid-term prognosis is generally poor.
Assuntos
Equinococose Pulmonar/complicações , Embolia Pulmonar/etiologia , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Equinococose Pulmonar/diagnóstico , Evolução Fatal , Feminino , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Embolia Pulmonar/diagnóstico , Estudos RetrospectivosRESUMO
Pleural effusion is rarely observed in multiple myeloma, its frequence is estimated at 6%, and its myelomatous origin occurs in only 1% of the cases. It is exceptionally the first sign of multiple myeloma. We report two cases of IgA and IgG multiple myeloma revealed by pleural effusion. The first case was a 61-year-old woman who developed pleural effusion with a bone endobronchial and pericardial location of multiple myeloma; the second case was a 65-year-old man who had isolated pleural effusion. These pleural effusions were found to be caused by myeloma and were verified by the presence of the same monoclonal immunoglobulin in both plasma and pleural liquid. Atypical plasma cells were found in the pleural fluid.
Assuntos
Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Derrame Pleural/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Hydatid disease of bone is very rare accounting for 0.5% - 3% of all localisations. CASE REPORT: We report the case of a woman of 30 years who presented with posterior chest pain. The chest radiograph showed an extra-pulmonary mass associated with a lytic rib lesion. Thoracic ultrasound revealed a multiloculated soft tissue and fluid mass. CT scan showed a fluid filled costo-vertebral cyst. MRI identified extension into the spinal canal. Pathological examination of the surgically resected material confirmed the diagnosis. CONCLUSIONS: This observation emphasises the role of MRI in assessing the extent of hydatid cysts of the posterior chest wall and in particular invasion of the spinal canal.
Assuntos
Doenças Ósseas/parasitologia , Doenças da Medula Espinal/parasitologia , Adulto , Doenças Ósseas/patologia , Dor no Peito/etiologia , Equinococose , Feminino , Humanos , Imageamento por Ressonância Magnética , Costelas/parasitologia , Costelas/patologia , Doenças da Medula Espinal/patologiaRESUMO
Broncho-pulmonary adenocarcinoma get interest since many years because his increased prevalence. Between december 1998 and January 70 male patients, mean age 56 years, with broncho-pulmonary adenocarcinome were collected retrospectively. The epidémiologic, clinic, radiologic and evolutive data of this pathologic form of cancer was studied. The ratio increased from 10% in 1988 to 14% in 1996. Clinic manifestations was common. Radiologic features was represented essentially by a unique (82%) and péripheric (56%) opacity. The diagnosis, based on cytologic and histologic data, was assessed in 39% of cases by endoscopic biopsy. The investigation for the primitive neoplasic process was made in 18% of patients and found only 2 cases of extra-pulmonary neoplastic process. Curative treatment based on surgery is performed only in 28% of our patients regarding the advanced stage of disease explaining the low survival rates.
Assuntos
Adenocarcinoma/epidemiologia , Adenocarcinoma/terapia , Neoplasias Brônquicas/epidemiologia , Neoplasias Brônquicas/terapia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Adenocarcinoma/diagnóstico , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia , Neoplasias Brônquicas/diagnóstico , Broncoscopia , Terapia Combinada , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Pneumonectomia , Prevalência , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Tunísia/epidemiologiaRESUMO
Intra muscular metastasis are rare. They usually occurs during the course of a cancer. The primary bronchial carcinoma is the most common. Clinical features include painful mass, frequently, they are symptomatic. Sonography CT scan and MR imaging shows a non specific abnormally, but they defined their seat and their extension. The authors report a case of metastases of epidermoid bronchial carcinoma to left adductor muscle and gives a review of the literature.
Assuntos
Neoplasias Pulmonares/patologia , Neoplasias Musculares/secundário , Idoso , Humanos , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético/patologia , Tomografia Computadorizada por Raios XRESUMO
Local treatment with intra vesical BCG for bladder carcinoma have few complications. Pulmonary side effects are rare, like interstitial pneumonitis. We report a case of a 77-year-old man, treated with BCG for bladder carcinoma who developed illness and tumoral chest-X-ray opacity. Mycobacterium tuberculosis bovis was isolated in culture and 2 years after in sputum. Physio pathologic mechanism of pulmonary features remains controversial, however this case suggest that lung lesions can be result of an infection process.
Assuntos
Antineoplásicos/efeitos adversos , Vacina BCG/efeitos adversos , Tuberculose Pulmonar/induzido quimicamente , Idoso , Antineoplásicos/uso terapêutico , Vacina BCG/uso terapêutico , Humanos , Masculino , Mycobacterium bovis/isolamento & purificação , Mycobacterium bovis/patogenicidade , Escarro/microbiologia , Neoplasias da Bexiga Urinária/tratamento farmacológicoRESUMO
Hydatidosis is an endemic affection in our country. Hepatic and pulmonary localisation is the most frequent. The other localisation especially in the bone, are exceptional. We report 2 cases of costal hydatid diagnosed on 17 and 33 years old male patients admitted for parietal tumor respectively localized in cervix and thorax. The diagnosis, suspected on chest tomography is confirmed by histologic patterns of resected rib.
Assuntos
Doenças Ósseas Infecciosas/parasitologia , Equinococose/patologia , Adolescente , Adulto , Doenças Ósseas Infecciosas/cirurgia , Equinococose/cirurgia , Humanos , Masculino , Costelas/parasitologia , Costelas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Thymolipoma is an uncommon benign tumor of the thymus. Asymptomatic, it is an incidental discovery. Pathogenesis remains controversial. We report a new case in a 36-year-old woman that was discovered on a chest x-ray ordered for pneumonia. The MRI findings suggested the diagnosis which was confirmed at the pathology examination of the surgical specimen.
Assuntos
Lipoma/patologia , Neoplasias do Timo/patologia , Adulto , Biópsia , Feminino , Humanos , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Prognóstico , Radiografia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgiaRESUMO
INTRODUCTION: Malignant primary tumours occurring in the thorax encompass a large group of tumours which may arise from the lung, mediastinal structures, the pleura or the chest wall. OBSERVATION: We report the case of a 37 year old patient, who presented with left sided chest pain. On clinical examination a right sided chest wall mass was identified. Chest X Ray showed a left sided upper mediastinal opacity, associated with a left sided pleural opacity. Thoracic CT scan revealed a large mass arising from the chest wall and infiltrating the mediastinum associated with a second chest wall mass at the level of the 8(th) and 9(th) right ribs. The biopsy of the chest wall mass revealed it to be a parietal synovialosarcoma. The patient responded to chemotherapy based on ifosfamid and doxorubicin as well as mediastino-pulmonary radiotherapy. There was an improvement in the patient's clinical and radiological state but the patient died by pulmonary embolism after the 3(rd) cause of treatment. CONCLUSION: Chest wall synovialosarcoma has a poor prognosis, however, its chemosensitivity means that treatment may initially be effective.
Assuntos
Sarcoma Sinovial/patologia , Neoplasias Torácicas/patologia , Parede Torácica/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Dor no Peito/etiologia , Terapia Combinada , Doxorrubicina/administração & dosagem , Evolução Fatal , Humanos , Ifosfamida/administração & dosagem , Masculino , Complicações Pós-Operatórias , Embolia Pulmonar/complicações , Radioterapia Adjuvante , Sarcoma Sinovial/tratamento farmacológico , Sarcoma Sinovial/radioterapia , Sarcoma Sinovial/cirurgia , Neoplasias Torácicas/tratamento farmacológico , Neoplasias Torácicas/radioterapia , Neoplasias Torácicas/cirurgia , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Amyloidosis is characterized by tissue deposits of amyloid material. Secondary amyloidosis can occur as a sequel to pulmonary tuberculosis over a relatively long period. However, this was not the case with our patient. Subsequently we conducted a literature review to try to explain the unusual course of AL amyloidosis in our patient. CASE REPORT: A 36- year-old patient was admitted to our department for investigation of haemoptysis. A diagnosis of primary pulmonary tuberculosis was made and antituberculous treatment was started. On the second day of treatment, a haematoma appeared on the sole of the right foot, which spread down to the toes during the following days. Renal investigations showed a 24h proteinuria of 9 g/L and serum protein electrophoresis revealed an albumin level of 11.8 g/L. A diagnosis of nephrotic syndrome was made. A renal biopsy was indicated but this was not possible on account of a marked worsening of the patient's condition after 14 days of treatment. The patient's level of consciousness deteriorated and he was transferred to the intensive care unit for ventilation. He died 48 hours later. Post-mortem histological examination of pulmonary and cutaneous tissue revealed AL amyloid deposits. CONCLUSION: In view of the association of active pulmonary tuberculosis and a pulmonary localisation of amyloidosis, a causal relationship is not definite. Coexistence of active pulmonary tuberculosis and primary amyloidosis must also be considered, particularly as the immunohistochemical characterisation revealed AL amyloidosis.